Diagnostic Value of Cardiac Magnetic Resonance Imaging and Intracoronary Optical Coherence Tomography in Patients With a Working Diagnosis of Myocardial Infarction With Non-obstructive Coronary Arteries – A Systematic Review and Meta-analysis

Balakrishna, Akshay Machanahalli; Ismayl, Mahmoud; Thandra, Abhishek; Walters, Ryan W.; Ganesan, Vaishnavi; Anugula, Dixitha; Shah, Dipan J.; Aboeata, Ahmed

doi:10.1016/j.cpcardiol.2022.101126

Cited by 18 publications

(12 citation statements)

References 62 publications

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“…Multimodality imaging, both invasive and non-invasive, is critical to determining the underlying diagnosis of MINOCA. As outlined above, each modality has its limitations in reaching the underlying diagnosis; however, the diagnostic yield significantly improves when coupled ( 94 , 95 ). The HARPP study demonstrated the combination of OCT and CMRI resulted in a diagnosis in 85% of the cases whereas OCT alone was diagnostic in 46% and CMRI alone in 74% of cases ( 27 ).…”

Section: Diagnostic Modalities For Minocamentioning

confidence: 99%

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Yildiz

Ashokprabhu

Shewale

et al. 2022

Front. Cardiovasc. Med.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is evident in up to 15% of all acute myocardial infarctions (AMI) and disproportionally affects females. Despite younger age, female predominance, and fewer cardiovascular risk factors, MINOCA patients have a worse prognosis than patients without cardiovascular disease and a similar prognosis compared to patients with MI and obstructive coronary artery disease (CAD). MINOCA is a syndrome with a broad differential diagnosis that includes both ischemic [coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), and coronary embolism/thrombosis] and non-ischemic mechanisms (Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy)—the latter called MINOCA mimickers. Therefore, a standardized approach that includes multimodality imaging, such as coronary intravascular imaging, cardiac magnetic resonance, and in selected cases, coronary reactivity testing, including provocation testing for coronary vasospasm, is necessary to determine underlying etiology and direct treatment. Herein, we review the prevalence, characteristics, prognosis, diagnosis, and treatment of MINOCA -a syndrome often overlooked.

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Section: Diagnostic Modalities For Minocamentioning

confidence: 99%

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Yildiz

Ashokprabhu

Shewale

et al. 2022

Front. Cardiovasc. Med.

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“…However, pathologies with similar presentation, previous myocardial damage or presence of chronic myocarditis can cause misdiagnosing with isolated use of CMR, as specificity reportedly declines in patients with a subsequent EMB performed [ 8 , 9 , 10 , 11 ]. Still, there is a good correlation between CMR and EMB findings, with up to 78% overall accuracy when updated Lake Louise criteria are applied [ 4 , 12 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

“…Technology advancements of CMR and studies of its application have shown a considerable rise in its diagnostic accuracy when used alone [ 4 , 12 , 13 ], a predictive capacity of the method in patients surviving myocarditis [ 14 , 15 , 16 ] and potential of improvement. Furthermore, CMR can detect findings typical for eosinophilic myocarditis—intracardiac thrombosis and subendocardial fibrosis, and myocardial mapping can be used for further differentiation [ 1 , 17 , 93 , 129 ], introducing an alternative for diagnosis of one of the specific subtypes of myocarditis.…”

Section: Discussionmentioning

confidence: 99%

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

et al. 2022

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Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.

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“…It allows visualization of transmural myocardial flow and assessment of microvascular function in patients suspected with microvascular angina ( 104 ). Meanwhile, CMR is crucial for the diagnosis of MINOCA, due to its perfect ability to exclude acute myocarditis and Takotsubo cardiomyopathy ( 105 ). Moreover, CMR is non-invasive and non-radioactive, therefore, CMR is an ideal method to evaluate the microcirculatory dysfunction of MINOCA, especially high-resolution late gadolinium enhancement CMR ( 106 ).…”

Section: Coronary Functional Assessment In Non-obstructive Cadmentioning

confidence: 99%

Coronary functional assessment in non-obstructive coronary artery disease: Present situation and future direction

Zhai

Fan

Zhu

et al. 2022

Front. Cardiovasc. Med.

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Non-obstructive coronary artery disease (CAD), which is defined as coronary stenosis <50%, has been increasingly recognized as an emerging entity in clinical practice. Vasomotion abnormality and coronary microvascular dysfunction are two major mechanisms contributing to the occur of angina with non-obstructive CAD. Although routine coronary functional assessment is limited due to several disadvantages, functional evaluation can help to understand the pathophysiological mechanism and/or to exclude specific etiologies. In this review, we summarized the potential mechanisms involved in ischemia with non-obstructive coronary arteries (INOCA) and myocardial infarction with non-obstructive coronary arteries (MINOCA), the two major form of non-obstructive CAD. Additionally, we reviewed currently available functional assessment indices and their use in non-obstructive CAD. Furthermore, we speculated that novel technique combined anatomic and physiologic parameters might provide more individualized therapeutic choice for patients with non-obstructive CAD.

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Diagnostic Value of Cardiac Magnetic Resonance Imaging and Intracoronary Optical Coherence Tomography in Patients With a Working Diagnosis of Myocardial Infarction With Non-obstructive Coronary Arteries – A Systematic Review and Meta-analysis

Cited by 18 publications

References 62 publications

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

Coronary functional assessment in non-obstructive coronary artery disease: Present situation and future direction

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